What you should cover

• Ask about the duration and nature of cough, dyspnoea, wheezing, thoracic pain, upper respiratory tract symptoms, smoking, and use of drugs. Explore restrictions in activities as a result of the cough.

• Are the symptoms caused by a self limiting or serious illness? Acute cough (less than three weeks) is most commonly caused by self limiting infections of the respiratory tract. Consider other common causes: (passive) smoking, bronchial hyper-reactivity, use of angiotensin converting enzyme inhibitors, postnasal drip, and gastro-oesophageal reflux disease (unlikely with no history of heartburn or regurgitation).

• Consider pneumonia—factors associated with an increased risk include use of oral glucocorticosteroids, heart failure, chronic obstructive pulmonary disease (COPD), insulin dependent diabetes, serious neurological disorder, rheumatoid arthritis, Parkinson’s disease, cancer, and older age (especially over 80).

• Asthma must be considered but is unlikely with no history of respiratory or atopic problems. COPD should be considered in smokers. Persisting paroxysms of cough, sometimes with vomiting, suggest whooping cough. Assess for less …